Kilfiness Walker
Summary
Encouraging and analytical problem-solver with a unique set of skills contributing to effective team building, leadership, and motivation. Exceptional aptitude for customer relations and relationship-building, fostering positive connections with clients. Proficient in independent decision-making and sound judgment, consistently making impactful contributions to company success. Dedicated to applying training, monitoring, and morale-building abilities to enhance employee engagement and boost overall performance.
Overview
9
9
years of professional experience
Work History
Senior Insurance Follow Up Representative
Annuity One LLC
04.2023 - Current
- Senior Insurance Follow-up Representative will be responsible for all collection functions for hospital and physician services
- Primary duties will include reviewing specialty accounts, assigned payers, escalated accounts receivable concerns, special projects, following up with insurance companies on claim status, gathering and submitting any missing information, rebilling, appeals, and billing out secondary electronic or paper claims to all payers as needed
- Ultimately, it results in account resolution
- Works closely with Team Lead and team to ensure client success
- Displays and encourages a positive attitude and the importance of teamwork
- Able to communicate effectively with management and the team
- Assists Team Lead with training new and existing team members as needed
- Identifies and works higher-level AR Reduction projects assigned by management
- Serves as client subject matter expert and assists Team Lead with answering team questions regarding client policies and procedures
- Research remits and Explanation of Benefits (EOBs) for complete accurate payments or denials
- Submits corrected claims or appeals
- Requests appropriate adjustments, when required
- Identify items that require client assistance and report to Team Lead/Supervisor
- Gather payor trends and provide feedback to management
- Meets and exceeds team productivity and quality standards
- Ensures legal compliance by following company policies and guidelines, as well as state and federal insurance regulations
- All other duties as assigned by management
- Streamlined coordination between medical providers and insurance companies by serving as a reliable point of contact for all claim-related matters.
- Optimized workflow productivity through diligent organization and prioritization of daily tasks, resulting in swift resolution of outstanding issues.
- Delivered comprehensive training programs for new hires on the nuances of insurance follow-up procedures, fostering a knowledgeable and capable workforce.
Revenue Recycle Claims Specialist (Remote)
PhyCare Solutions Incs
01.2022 - 06.2023
- Senior Insurance Follow-up Representative will be responsible for all collection functions for hospital and physician services
- Primary duties will include reviewing specialty accounts, assigned payers, escalated accounts receivable concerns, special projects, following up with insurance companies on claim status, gathering and submitting any missing information, rebilling, appeals, and billing out secondary electronic or paper claims to all payers as needed
- Ultimately resulting in account resolution
- Work with third party payers using the Epic system to ensure proper reimbursement on patient accounts: Identify and prepare adjustments and write-offs as appropriate
- Analyze and research unpaid claims, and assist in the resolution of denials, partial payments, and payment variances
- Interface with insurance companies via telephone or web portal to check claim status
- Checks payer feedback on submitted claims Notes all further action taken prior to claim being resubmitted to a payer
- Review payor correspondence
- Adjusts corrections on denied claims that were due to missing information or change in patient status
- Follow up on No activity claims
- Status claims and follow up with payors and patients
- Utilize payor portal and other tools
- Perform follow-up calls and written correspondence to patients and payers in accordance with Company policies
- Other responsibilities as identified by AR Manager
- Enhanced customer satisfaction with timely communication, empathy, and clear explanations of claim outcomes.
- Managed a high volume of claims effectively by prioritizing tasks and maintaining excellent organizational skills.
- Handled high-pressure situations with professionalism and composure, consistently achieving positive outcomes for both clients and the organization.
- Settled complex claims fairly by applying critical thinking, negotiation skills, and detailed knowledge of insurance policies.
- Delivered comprehensive training sessions for new hires on claims handling procedures, policy interpretation basics, negotiation techniques, and other core competencies related to the role of a Claims Specialist.
Team Lead Adjudication Specialist/Fact Finder (Remote)
Corestaff/Maximus
10.2020 - 10.2021
- Company Overview: Colorado Springs, CO
- Research UI claims for the state of Colorado and respond to written and telephone inquiries from customers regarding unemployment claim status, program requirements and procedures
- Make determinations on eligibility on 50 and 40 issues and complete written decisions to parties of interest following policy, legal precedents and state and federal law
- Review reports on unemployment insurance activity; identify and correct errors and conduct follow-up with appropriate parties as necessary
- Colorado Springs, CO
- Trained new team members by relaying information on company procedures and safety requirements.
- Promoted a positive work environment by fostering teamwork, open communication, and employee recognition initiatives.
- Coached team members in techniques necessary to complete job tasks.
- Collaborated with other department leads to streamline workflows, improve interdepartmental coordination, and achieve business goals collectively.
Revenue Recycle Claims Specialist (Remote)
INDOTRONIX/ATOS
03.2020 - 10.2020
- Company Overview: Clearwater, FL
- AR collections and follow-up
- Working knowledge of third-party payers, billing requirements, medical terminology, and system applications Ability to work remotely in a secure home office location Medicare, Managed Care, Blue Cross, Work Comp and other payer experience preferred
- Patient Accounting/EHR/billing systems experience with FACS, EPIC, Cerner, Meditech, Paragon, Epremis Hospital coding and billing
- Ability to work independently Maintains a high quality of work in a timely manner Ability to solve problems with research abilities Great attention to detail Communicate with appropriate party (insurance company, attorney, place of employment, insured, etc.) for prompt account resolution
- Accurately document accounts with correct information received and take appropriate system action
- Inform Team Supervisor of any payor or other issues effecting collections
- Audit assigned work to assure accounts are addressed timely
- Identify trends found during follow up process
- Navigate insurance portals and upload medical records
- Analyze and interpret insurance denials
- Write and upload appeals and reconsiderations
- Clearwater, FL
- Enhanced customer satisfaction with timely communication, empathy, and clear explanations of claim outcomes.
- Managed a high volume of claims effectively by prioritizing tasks and maintaining excellent organizational skills.
- Conducted regular audits of claim files, ensuring compliance with internal and external regulations and standards.
Senior Prior Authorization Specialist
CMT Solutions/Cover My Test
03.2018 - 07.2020
- Company Overview: Orlando, FL
- Work assigned prior authorizations; initiate requests, follow-up to provide additionally required information, track progress and expedite responses from insurance carriers and other payers
- Ensure that all work is processed in compliance with our client service level agreements and company policies and procedures
- Track, report and escalate service issues arising from requests for authorizations, program eligibility or other issues that delay service, to ensure patient access and avoiding delays that interrupt therapy
- Document case activity, communications and correspondence in computer system to ensure completeness and accuracy of patient contact records in compliance with company requirements and the Service Level Agreements
- Perform or assist with any operations, as required to maintain workflow and to meet schedules and quality requirements
- Accept additional responsibilities and/or projects as directed by leadership
- Orlando, FL
- Collaborated with physicians to obtain necessary clinical information for prior authorization submissions.
- Maintained thorough knowledge of insurance plan requirements, facilitating accurate and timely completion of authorization forms.
Accounts Receivable Specialist/Claims Resolutions
A-LINE/CVS-CORAM SPECIALTY INFUSION
07.2018 - 12.2018
- The process of claims that has been denied determined what is needed to resolve the issues to receive payment from the payer
- Resolve errors and make claim edits assigned in work queues Follow work list prioritization of accounts for resolving accounts and/or submitting claims
- Contact payers and patients when necessary for PFS processes
- Request relevant information from appropriate Revenue Cycle and clinical departments as required through the course of the PFS processes
- Make necessary adjustments to patient demographic, insurance, and account balance information
- Complete A/R adjustments and request other adjustments where permitted and appropriate
- Adhere to all regulatory compliance areas, policies and procedures (including HIPAA and PCI compliance requirements), and 'leading practices'
- While working with Champ VA, Tricare West, Tricare for Life, Humana Military (Tricare East), Medicare for both drugs and DME equipment understanding of the process of the claim
- I assist with training for new hires as well as on the floor support to resolve trending issues with claims
- Reduced outstanding accounts receivable balances by diligently following up on overdue payments.
- Supported month-end closing activities by reconciling accounts, preparing reports, and analyzing trends in account performance.
- Increased efficiency of the collections process by implementing new strategies and procedures for tracking delinquent accounts.
Pharmacy Billing Specialist
Professional Staffing Solutions/ Florida Hospital
01.2018 - 07.2018
- Company Overview: Maitland, FL
- Under general supervision, is responsible for processing insurance and billing insurance in a timely manner
- Reviews assigned electronic claims and submission reports
- Resolves and resubmits rejected claims appropriately as necessary
- Processes daily and special reports, unlisted invoices and letters, error logs, stalled reports and aging
- Performs outgoing calls to patients and insurance companies to obtain necessary information for accurate billing
- Answers incoming calls from insurance companies requesting additional information and/or checking status of billings
- Adheres to all company policies and procedures
- Adheres to Florida Hospital Corporate Compliance Plan and to all rules and regulations of all applicable local, state and federal agencies and accrediting bodies
- Actively participates in outstanding customer service and accepts responsibility in maintaining relationships that are equally respectful to all
- Maitland, FL
- Researched and resolved billing discrepancies to enable accurate billing.
- Worked with multiple departments to check proper billing information.
- Identified, researched, and resolved billing variances to maintain system accuracy and currency.
- Assisted colleagues in resolving complex billing issues, promoting teamwork and knowledge sharing within the department.
Account Receivable Billing and Reimbursement
Robert Half- Prime Therapeutics
08.2017 - 01.2018
- Company Overview: Orlando, FL
- Under general supervision, is responsible for processing insurance claims, expediting billing and payments for insurance claims
- Processes daily and special reports, unlisted invoices and letters, error logs, stalled reports and aging
- Performs outgoing calls and correspondence to patients and insurance companies to obtain necessary information for accurate billing
- Responds to incoming calls from insurance companies requesting additional information and/or checking status of billings
- Adheres to Prime Therapeutics Compliance Plan and to all rules and regulations of all applicable local, state and federal agencies and accrediting bodies
- Actively participates in outstanding customer service and accepts responsibility in maintaining relationships that are equally respectful to all
- Orlando, FL
Behavioral Health Benefits
USTECH SOLUTIONS AETNA
01.2017 - 05.2017
- Company Overview: Orlando, FL
- I have the responsibility of a benefits eligibility clerk to provide the details of the benefits for providers for Substance abuse and Behavioral health benefits
- I also give referrals to members and providers to facilities as well as providers that are in network by reviewing the benefits to see if the member plans which participate with the member behavioral health benefits
- They interview clients and explain thoroughly each program's benefits package, as well as eligibility requirements, including financial, medical, and residential factors such as copays, deductible, coin and max out of pockets
- I assist member with behavior health benefits management for Coventry, Advantage, People health, multiple Medicare manage plans
- Orlando, FL
Lead Reimbursement Specialist
KELLY SERVICES-EXPRESS SCRIPTS
02.2016 - 11.2016
- Company Overview: Orlando, FL
- Prepares and reviews claims to ensure billing accuracy according to payer requirements, including but not limited to codes, modifiers, pricing, dates and authorizations
- Pursues collection activities to obtain reimbursement from payers and/or patients for Accredo specialty pharmacy of Express
- Scripts
- Collections on past due deductible, coinsurance, and any past due balance before shipping
- Frequent follow up with payers and/or patients on outstanding accounts Escalates delinquent and/or complex claims to Lead Reimbursement Specialist for appropriate actions
- Verify insurance coverage for potential new patients responsible for verifying patient insurance coverage over the phone with a variety of insurance providers
- Responsible for calculating co-insurances, co-payment amounts based on deductibles, Coverage % and out of pocket expense
- Re-verify insurance coverage for existing patients in order to process patient prescription needs
- Daily contact with patients, insurance companies and local pharmacy to obtain the authorization for the prescription
- Demonstrate excellent customer service to patients, healthcare professionals and insurance carriers
- Performs clinical coverage review of post service, pre-payment claims, which requires interpretation of state and federal mandates, applicable benefit language, medical & reimbursement policies, coding requirements and consideration of relevant clinical information on claims with over billing patterns
- Performs clinical coding review to ensure accuracy of medical coding and utilizes clinical expertise and judgment to determine correct coding & billing
- Identifies over billing patterns and trends, waste and error, and recommends providers to be flagged for review
- Remote hiring from Michigan for the position
- Orlando, FL
Education
A.S. - Medical Insurance Billing Coding
EVEREST UNIVERSITY
Orlando, FL05.2012
Skills
- SME/Coaching Training-Accounts Receivable
- 8 years of EPIC Certified HB professionals claim A/R Collections Specialist
- 4 years EPIC MCO Medicare
- 3 years EPIC Charge Entry
- Medical Claims Resolutions Specialist
- Medical Billing and Coding Specialist (DME)
- Home Infusion Claims
- Worker Comp claims
- Fraud Claims Specialist
- Quality Control Clerk
- Financial Advisor
- Mail handler
- Cerner
- Insurance Verification
- EMR Systems
- ICD-9
- Medical Records
- CPT Coding
- HIPAA
- ICD-10
- PCI
- Behavioral Health
- Contracts
- Medical collection
- Root cause analysis
- Hospital Experience
- Managed Care
- Claims processing
- Account resolution
- Insurance verification
- EOB analysis
- Data entry
- Team collaboration
- Training and development
- Problem solving
- Time management
- Priority management
- Communication skills
- HIPAA compliance
- Attention to detail
- Problem resolution
- Assertiveness
- Medical billing
- Follow-up procedures
- Goal orientation
- Claim processing expertise
- Teamwork and collaboration
- Problem-solving
- Product knowledge
- Medical terminology
- Analytical thinking
- Professionalism
- Emotional intelligence
Accomplishments
- Supervised team of 18 staff members.
- Documented and resolved EPIC which led to claims resolutions.
- Used Microsoft Excel to develop inventory tracking spreadsheets.
Timeline
Senior Insurance Follow Up Representative
Annuity One LLC
04.2023 - Current
Revenue Recycle Claims Specialist (Remote)
PhyCare Solutions Incs
01.2022 - 06.2023
Team Lead Adjudication Specialist/Fact Finder (Remote)
Corestaff/Maximus
10.2020 - 10.2021
Revenue Recycle Claims Specialist (Remote)
INDOTRONIX/ATOS
03.2020 - 10.2020
Accounts Receivable Specialist/Claims Resolutions
A-LINE/CVS-CORAM SPECIALTY INFUSION
07.2018 - 12.2018
Senior Prior Authorization Specialist
CMT Solutions/Cover My Test
03.2018 - 07.2020
Pharmacy Billing Specialist
Professional Staffing Solutions/ Florida Hospital
01.2018 - 07.2018
Account Receivable Billing and Reimbursement
Robert Half- Prime Therapeutics
08.2017 - 01.2018
Behavioral Health Benefits
USTECH SOLUTIONS AETNA
01.2017 - 05.2017
Lead Reimbursement Specialist
KELLY SERVICES-EXPRESS SCRIPTS
02.2016 - 11.2016
A.S. - Medical Insurance Billing Coding
EVEREST UNIVERSITY
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